Supplementary Health and Dental Plans
The procedure in presenting an appeal based on the Health Care plan is the following:
- If you do not agree with the initial decision of health care plan provider (HCPP), submit your request for a review in writing to the HCPP.
- If you do not agree with the review decision, contact either the NAV CANADA Benefits Section at 1-888-774-4732, option 2. You will be required to provide a copy of the claim in dispute and the response provided by the HCPP. If personal medical information is required to pursue potential adjustment to the claim, written consent must be provided before any further action will and can be taken. The documents belonging to the HCPP are made available to the Benefits Section or the NAV CANADA Joint Council Secretariat for consideration during the appeal. All such documents remain the sole property of the HCPP and no copies are to be made. All documents so obtained immediately upon completion of the consideration of the appeal, shall be returned to the HCPP. Neither the Benefits Section nor the NAV CANADA Joint Council will instruct the HCPP to reimburse the appellant in cases where the HCPP disagrees with the interpretation without the agreement of the benefits committee.
- In the event that the response at this level is not satisfactory, you have the right to file an appeal with the NAV CANADA Joint Council’s Benefits Committee. A written request must be forwarded to the NAV CANADA Joint Council Secretariat for consideration at the next meeting of the Benefits Committee. The case file always eliminates the name of the appellant to protect their identity during the review. Appeals should be submitted through either the Benefits Section at firstname.lastname@example.org or the NCJC General Administrative Secretary at email@example.com.
- The benefits committee schedules the appeal and considers the information to determine if the HCPP has interpreted the benefits plan correctly. In the case where the benefits committee finds that the benefits plan has not been interpreted correctly, the Board provides direction to the HCPP.
N.B. Where the benefits committee determines the HCPP has interpreted the health plan correctly, there is no further appeal process.